Introduction
Back pain is a phenomenon that happens to everyone once in a lifetime. The pain can also manifest itself by a pulling or burning sensation in the back. Sometimes we know the cause relatively precisely, for example, if we have misplaced ourselves or injured ourselves during sports.
Sometimes, however, the pain is chronic and the search for the cause or treatment is difficult. In such cases, patients often have been through an odyssey of many years across many different surgeons, orthopaedic surgeons and physiotherapists and still feel pain. The problem with back pain is that there is a wide variety of causes, from early learning of incorrect movement patterns, to bone malpositions, to nerve compression with consecutive muscle loss. The large number of articles on the subject of back pain also shows how many people are affected and the volume of this disease in the health care market. This article aims to shed light on the exact causes of the most common back pain, as well as its localization on the back.
Symptoms
The symptoms of back pain are widely known to us all: When suddenly every movement causes pain in the back, the head can no longer be turned, or bending and lifting movements cause great pain, then we speak of back pain. The pain can come slowly – over weeks – or quickly, in the form of a “lumbago“. Often one wakes up in the morning and feels pain in the entire neck.
This is usually the case when we have misplaced ourselves. Depending on the origin of the back pain, one can draw conclusions about different causes. It is therefore especially important to discuss the symptoms in detail.
Whether the pain radiates into other parts of the body also plays a diagnostic role. In combination with newly occurring paralysis symptoms, this complex of symptoms forms a so-called “red flag”, i.e. an alarm signal requiring clarification. In this case, no time should be lost and a quick clarification should be made with the doctor.
Since the causes can be very diverse, it is difficult to give a clearly structured classification. However, since patients in everyday life can usually only indicate the location of the pain and, if necessary, the process of its development, the causes are explained below on the basis of the anatomical conditions: If the back pain occurs to a limited extent on the right side of the back, in the simplest case there is a pulled muscle. This can occur after heavy lifting, after excessive sporting activity, or after a trauma, such as an accident.
Over the entire length of the back, the muscle errector spinae, or “spinal erector spinae”, pulls. It actually consists of many other small muscle strands and pathways, but these are not defined in a completely uniform way anatomically, which is probably due to the complexity of the back muscles. The M. errector spinae is located on both sides of the spine and has the task of straightening the trunk, for example, when we want to straighten up again after bending down or stretching.
It is a very strong and long muscle that can cause pain during the above-mentioned movements. Classically, it is affected when lifting heavy loads when they are lifted “out of the back” and not “out of the legs” as recommended. Of course, almost any other muscle of the back muscles can be affected at any time, and typically the well-known “lumbago” can also occur when lifting loads.
However, the M. errector spinae is of particular importance in isolated left-sided pain, because it represents a large muscle volume on the right and left side of the spine, symmetrically arranged. Muscle strains can therefore occur on the left or right side after overloading the “spinal erector spinae”, but, as already mentioned, there are many other large muscles in the back that are affected by a strain. It should be mentioned that the muscles of the back are naturally symmetrical, and all the causes listed above apply to both the right and left side.
Another large muscle on the back that can cause pain when pulled is the latissimus dorsi muscle. It is especially well known among bodybuilders and strength athletes, because it makes the back appear broader – if trained sufficiently: It pulls at about the height of the hip to the shoulder and is responsible for internal rotation and for bringing the arm closer to the body.In terms of area, it forms the largest skeletal muscle of the entire body! When viewed from the front, it lifts off the ribs at the side when trained and moves over the armpit to the shoulder.
Excessive strain as well as incorrect loading can lead to strains of this muscle and consequently to left (or right) side back pain. In both cases, rest and abstinence from training for several days is usually enough to make the pain disappear. This gives the body enough time to regenerate the broken muscle fibers and restore the anatomical structures.
If the pain has not disappeared after several days, a further imaging examination should be performed. A third region that should be mentioned at this point is the so-called “regio nuchae”, or simply the neck. Anatomically, the neck forms a very complex structure of many different, relatively small muscles.
This is due to the fact that the neck muscles have to fulfill a number of tasks that are mainly related to the movement of our head. These include stretching, bending, twisting, and tilting the head. Anatomically, the neck muscles do not form part of the back muscles, but functionally, they are the continuation of the back muscles in the direction of the head, and should therefore also be mentioned at this point.
In principle, neck pain occurs with any excessive strain on the six muscles of the neck. This can be the case with all of the above-mentioned movement patterns: Typically after long flights or bus trips, the neck hurts and we may have dozed off briefly, but in a position that is not good for the neck. Special neck supports may prevent this problem a little bit, but they cannot prevent it completely.
Since the head, including brain and skull, weighs 5-10 kilos, a constant weight tugs at the neck muscles – no wonder that many people do not really feel recovered after a short nap on the bus, since their neck now hurts. The pain can be in the middle, left or right of the neck, but can also radiate into the head and lower back. Fortunately, it usually goes away within hours.
Muscular imbalance or overstrain can therefore be a cause of back pain. Another group of injuries are deeper-seated injuries, such as herniated discs or nerve contusions. The latter are particularly dangerous because a nerve has only a certain tolerance limit and permanent damage can occur.
This then means a permanent failure of the musculature supplied by it. In this respect, we almost have to be thankful that bruised nerves loudly announce themselves in the form of pain when things get “too tight” for them. Lumbago is such a case: after jerky or clumsy movements, a strong pain suddenly shoots into the back.
The cause is always a contusion of the large sciatic nerve, either by a vertebral body or by reflexively tense muscles. The body responds to the sudden constriction of the nerve with an unpleasant shooting pain, usually in the lower back. As unpleasant as the pain is, it is also relatively harmless on the other hand, as long as no other symptoms such as paralysis or discomfort when going to the toilet are added.
In most cases, lumbago is self-limiting and disappears after a few days. In order to prevent lumbago, it is recommended to strengthen the back muscles with exercises, to pay attention to “healthy” movements (best example: do not lift from the cross, but from the legs), and to stretch the back. In the case of lumbago, the back pain is usually located in the hip area, as well as on the left and right of the spine.
To speed up the healing process, heat application (extensive warm to hot showers, a hot water bottle) and, if necessary, painkillers are recommended if the pain becomes too strong. The ribs can also be affected by back pain: In everyday life, we only know the ribs as the frontal part of the chest. However, the ribs move almost completely around the body and meet at the back at the spine, where they are attached by small joints.
Between the ribs are the so-called Musculi intercostales, also intercostal muscles. Their task is to contract during inhalation to increase the volume of the chest.So we need them to be able to breathe properly. In the case of so-called intercostal neuralgia, however, there is a persistent pulling pain in the chest and back area, which increases when we take a deep breath or cough.
This pain can be caused by a number of illnesses, but in the end they all have an irritation of the responsible nerve tracts as their cause. The pain occurs mainly in the chest area, but the back is also frequently affected. The therapy is causal, i.e. the cause, such as a nerve root cell lesion, is treated so that the pain disappears as a result.
If this is not possible, a symptomatic therapy with painkillers is used, in which the symptoms but not the cause are treated. Depending on their strength, the painkillers vary from freely available NSAIDs such as ibuprofen to opioids such as tilidine, to anesthetics such as fentanyl, which are also used in the operating room. The therapy of back pain is, similar to the causes, manifold and must always aim at the cause.
This is often not easy to find, due to the complexity of the back and the many anatomical structures that influence it. Short-term tensions, pulled muscles, or lumbago usually disappear within a few days, and usually do not require medical attention. The therapy depends on the symptoms.
It is important to take care, keep warm, and avoid the movement that causes them. Since this causes pain, one is anyway anxious not to perform it any more – and this is what our body wants to tell us with its pain reaction! One should become clairaudient, if with the back pain suddenly deafness feelings, tingling, and problems with urination or bowel movement arise.
This requires immediate medical clarification, since permanent damage can occur. If the pain cannot be controlled with non-opioids such as ibuprofen or paracetamol, opioids can also be prescribed by the doctor. However, these should be used with caution as they cause severe side effects such as addiction and drowsiness.
Among the non-opioids, paracetamol is the most suitable for use during pregnancy. However, you should always consult your doctor before taking it. Therapy with painkillers combats the symptoms, but in some cases surgical intervention is necessary to permanently eliminate the back pain.
This is the case, for example, with a herniated disc, as well as with all forms of permanent nerve compression, such as those caused by tumors or bone fractures. However, surgery is not a miracle cure either, and so many patients are frustrated after surgery because the pain is still present. At this point, it is important to have a realistic explanation from the surgeon, but also a physiotherapeutic post-operative treatment and possible rehabilitation. In combination, the greatest possible freedom from symptoms can indeed be achieved for many patients.
